| NPI | 1396099792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 57318) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL SW11085) |
| 1041C0700X Social Worker, Clinical (Licence: IL 149014436) | |
| Enumeration Date | 2012-11-07 |
| Last Update Date | 2013-03-19 |